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574 Exercise and Physical Activity in Diabetes Mellitus

Exercise and Physical Activity in

Diabetes Mellitus

Dr. N. VETRIVEL

Abstract
The global burden of diabetes, and associated meta- glyeridemia and ultimately increased cardiovascular
bolic disorders increasing immensely. Sedentary life risk. On the other hand, regular moderate to vigorous
style and blunder bus food habits are shown to pre- leisure time physical activity, structured aerobic exer-
dispose to cardio diabetic disease burden in modern cise or both can often reverse these adverse sequlae.
world. Regular physical activity, structured aerobic An appreciable increase in physical activity and daily
exercise or both can offer reversal of this adversi- energy expenditure also improves insulin action in
ty. Since ancient times, regular exercise activity has obesity with or without a concommitant reduction in
been recognized as an important tool in the man- body weight and fat stores. This is an important and
agement of the diabetes. Cardiovascular risk reduc- frequently overlooked salutary effect suggesting that
tion benefits of physical activity are manifold. They physical activity is as effective in preventing insulin
out-weigh the risk associated with exercise program. resistance as loosing body weight.
Prudent screening to be done to avert hypoglycemia
in T DM. Exercise guidelines and prescription to be Since ancient times of Sushrutha and Charaka reg-
1
in line with the recommendation of ADA and ACSM. ular physical exercise was recognized as an import-
Physical activity is much useful in the prevention of ant part of treatment of diabetes and frequently
T DM. prescribed during the pre- insulin era for those with
2 diabetes. Allen et al(1919), demonstrated that exer-
Introduction: cise lowers the blood glucose concentration and
transiently improves glucose tolerance in DM and in
The global burden of diabetes, pre-diabetes 1926 Lawrence observed that exercise potentiates
and associated metabolic disorders is exponentially the hypoglycemic effect of injected insulin. In spite
increasing. Currently 382 million people are affected of the salutary effects of achieving optimal blood glu-
and this number is estimated to rise to 592 million cose control, slightly more than half of individuals
by 2035. There is a pathophysiologic cascade by only with diabetes currently are reaching recognized
which physical inactivity predisposes to a cluster of treatment goals. Although, physical activity has long
cardio metabolic diseases including type 2 diabetes been considered a cornerstone of diabetes manage-
mellitus (T DM). With an increasingly sedentary life ment, prescribing specific exercise for individuals
2
style, skeletal muscle down regulates its capacity to with various types of diabetes including pre-diabetes
convert nutritional substances to ATP. Inactive skele- can be a daunting task for the time pressured health
tal muscles inability to oxidize glucose and fatty ac- care provider or the diabetes naive fitness profes-
ids is presumably mediated by several mechanisms sionals. A fundamental need in facilitation such of
including a) decreased mitochondrial concentration exercise prescription is an enhanced understanding
and oxidative enzymes b) a reduced ability to remove of the types of diabetes and how physical activity
glucose from blood because of fewer capillaries and requirements and abilities may differ among them.
diminished glucose transporters and c) an attenuated
capacity to hydrolyze blood triglycerides (TGL) to free Basics of Terminologies :
fatty acids (FFA) due to decreased lipoprotein lapse Before discussion moves to main topic, it is import-
activity. These metabolic disturbances collectively ant to understand vividly some terminologies used
reduce the somatic capacity to burn fuel resulting in exercise medicine. By definition, physical activity
in Hyperinsulinemia, Insulin resistance and Hypertri-
is any bodily movement produced by the contraction

GCDC 2017